[Factors related to sleep quality in Emergency Medical Technicians and their sleep habits during COVID-19 pandemic.]

OBJECTIVE: Emergency Medical Technicians (EMTs) show a high prevalence of sleep problems. Adding to these problems, another factor appeared two years ago: the COVID-19 pandemic. The objectives of this study were to describe the sleep quality and habits in a sample of EMTs in Spain during COVID-19 pandemic considering the factors related to them. METHODS: A national cross-sectional study was carried out in Spain between October 2020 and February 2021. EMTs who worked in basic and advanced life support ambulances were invited to participate in an online survey. Several sociodemographic variables were analyzed, as well as sleep quality, stress symptoms, pain, food consumption and physical activity. Logistic regression models were used to examine the associations between these variables and sleep quality. RESULTS: 340 EMTs participated in the study. Of them, 59.4% had poor sleep quality and the habits of 32.2% got worse during the pandemic. The EMTs with a poor sleep quality presented in higher proportion stress symptoms (OR: 4.19;95% CI: 2.16-8.11;p<0.001), pain (OR: 3.19;95% CI: 1.7-6.01;p<0.001) and a weekly consumption of sugar-sweetened beverages greater than two glasses (OR: 3.6;95% CI: 1.86-6.98;p<0.001). CONCLUSIONS: EMTs show a high prevalence of poor sleep quality, which got worse during the pandemic. The factors related to them are stress, pain and consumption of sugar-sweetened beverages. This study provides important information so that the emergency services can develop health promotion programs focused on these professionals.

Health promotion in the region of the americas: An educational innovation proposal

"Health Promotion in the Region of the Americas" is a collaboration by a team of experts from 14 countries with the objective to build capabilities for health promotion in the region. The first step of this journey was the creation of a web platform in the context of the COVID-19 global pandemic, a context that challenges the revision of development models, relationships, and training. It is a novel work because it implements the principles of an emancipatory health promotion, contributes to capacity building, promotes the construction and democratic access to high-quality information, and formalizes thoughtful spaces and the exchange of experiences. It is a living and dynamic process that is projected from a commitment to participation and co-responsibility for the construction of development models based on real proposals for health and life. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Effectiveness and Safety of Nirmatrelvir/ Ritonavir in Real Life Setting

Background and Importance On March 28th 2022, nirmatrelvir/ ritonavir was marketed in Spain. The Spanish Agency for Medicines and Medical Devices (AEMPS) established criteria to prioritise its administration in patients at high risk of progression to severe COVID. Data regarding the effectiveness and safety of nirmatrelvir in preventing severe coronavirus disease outcomes are limited. Aim and Objectives To assess the effectiveness and safety of nirmatrelvir/ritonavir in patients at high risk for severe COVID-19. Material and Methods Prospective descriptive study from April to August 2022 of patients treated with nirmatrelvir/ritonavir. Sociodemographic variables, vaccination status, hospital admission, high risk factors for progression and concomitant treatment were recorded. Readmissions were recorded within 30 days of the end of antiviral treatment. Results 53 patients were included with a mean age of 64 years, 51% women and 49% men. 57% were vaccinated with 3 doses, 17% with 2 doses, 9% with 4 doses, 6% with 1 dose and 11% were not vaccinated. 34% (18/53) were hospitalised at the time of initiation of treatment. The most prevalent high-risk criteria were: 24% active treatment with myelotoxic chemotherapy, 21% treatment in the previous 6 months with anti-CD20 drugs, 14% over 80 years vaccinated with some risk factor for progression, 7% patients with onco-haematological treatment and 7% in treatment in the previous 3 months with inhibitors of the proteinkinase. 3 treatments were performed off-label for persistent covid. The mean number of days from the onset of symptoms to the start of treatment was 1.6 days. 23% of patients required dose adjustment due to renal impairment. 53% required adjustment of chronic treatment for interactions, mainly with metamizole, statins, fentanyl and diazepam. 2 patients received remdesivir and sotrovimab, 2 remdesivir and another two sotrovimab. 4 (7%) patients were readmitted within 30 days after the end of treatment with nirmatrelvir ritonavir, 1 of them with persistent covid. One patient stopped treatment for hives. Conclusion and Relevance Nirmatrelvir ritonavir has been shown to be a safe and effective drug in high-risk patients of progression to severe covid.

Effectiveness and safety of nirmatrelvir/ritonavir in real life setting

Background and ImportanceOn March 28th 2022, nirmatrelvir/ritonavir was marketed in Spain. The Spanish Agency for Medicines and Medical Devices (AEMPS) established criteria to prioritise its administration in patients at high risk of progression to severe COVID. Data regarding the effectiveness and safety of nirmatrelvir in preventing severe coronavirus disease outcomes are limited.Aim and ObjectivesTo assess the effectiveness and safety of nirmatrelvir/ritonavir in patients at high risk for severe COVID-19.Material and MethodsProspective descriptive study from April to August 2022 of patients treated with nirmatrelvir/ritonavir. Sociodemographic variables, vaccination status, hospital admission, high risk factors for progression and concomitant treatment were recorded. Readmissions were recorded within 30 days of the end of antiviral treatment.Results53 patients were included with a mean age of 64 years, 51% women and 49% men. 57% were vaccinated with 3 doses, 17% with 2 doses, 9% with 4 doses, 6% with 1 dose and 11% were not vaccinated. 34% (18/53) were hospitalised at the time of initiation of treatment.The most prevalent high-risk criteria were: 24% active treatment with myelotoxic chemotherapy, 21% treatment in the previous 6 months with anti-CD20 drugs, 14% over 80 years vaccinated with some risk factor for progression, 7% patients with onco-haematological treatment and 7% in treatment in the previous 3 months with inhibitors of the proteinkinase. 3 treatments were performed off-label for persistent covid.The mean number of days from the onset of symptoms to the start of treatment was 1.6 days. 23% of patients required dose adjustment due to renal impairment.53% required adjustment of chronic treatment for interactions, mainly with metamizole, statins, fentanyl and diazepam.2 patients received remdesivir and sotrovimab, 2 remdesivir and another two sotrovimab.4 (7%) patients were readmitted within 30 days after the end of treatment with nirmatrelvir ritonavir, 1 of them with persistent covid. One patient stopped treatment for hives.Conclusion and RelevanceNirmatrelvir ritonavir has been shown to be a safe and effective drug in high-risk patients of progression to severe covid.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Guillain-Barre syndrome associated with SARS-CoV-2 infection: A case series from 4 Colombian cities during the pandemic

SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barre syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies;however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region;thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.Copyright © 2022 Sociedad Espanola de Neurologia

An outbreak in a pandemic in healthcare workers

BACKGROUND: An outbreak is defined as an increase in epidemiologically-associated cases greater than expected, during the 2019 Coronavirus pandemic 10.1% of cases are reported in healthcare workers in Mexico, however the circulation of the new Omicron variant with greater transmissibility is a risk for the occurrence of outbreaks. OBJECTIVE: Describes an outbreak of SARS-CoV-2 infection in health personnel of a pediatric hospital during the pandemic. METHODS: An outbreak study is carried out in health personnel diagnosed with SARSCoV- 2 infection, in a tertiary pediatric hospital, from January 1, 2021 to January 30, 2022. The increase in laboratory confirmed cases in January, higher than cases reported in the previous period indicated an outbreak and the need to strengthen prevention measures in the population. RESULTS: An outbreak with 508 cases in health personnel in January 2022 was confirmed, identifying 27.5% as in-hospital. The circulation of a new variant with high transmissibility, together with the relaxation of prevention measures due to the state of vaccination and the perception of a lower risk from COVID 19, are factors for the presence of the outbreak. CONCLUSIONS: It is important to continuously strengthen prevention measures and make staff adopt them as a daily behavior to avoid outbreaks. © 2022 Instituto Nacional de Pediatria. All rights reserved.

Impact of plasmapheresis on severe COVID-19.

The clinical course of COVID-19 may show severe presentation, potentially involving dynamic cytokine storms and T cell lymphopenia, which are leading causes of death in patients with SARS-CoV-2 infection. Plasma exchange therapy (PLEX) effectively removes pro-inflammatory factors, modulating and restoring innate and adaptive immune responses. This clinical trial aimed to evaluate the impact of PLEX on the survival of patients with severe SARS-CoV-2 and the effect on the cytokine release syndrome. Hospitalized patients diagnosed with SARS-CoV-2 infection and cytokine storm syndrome were selected to receive 2 sessions of PLEX or standard therapy. Primary outcome was all-cause 60-days mortality; secondary outcome was requirement of mechanical ventilation, SOFA, NEWs-2 scores modification, reduction of pro-inflammatory biomarkers and hospitalization time. Twenty patients received PLEX were compared against 40 patients receiving standard therapy. PLEX reduced 60-days mortality (50% vs 20%; OR 0.25, 95%CI 0.071-0.880; p = 0.029), and this effect was independent from demographic variables and drug therapies used. PLEX significantly decreased SOFA, NEWs-2, pro-inflammatory mediators and increased lymphocyte count, accompanied with a trend to reduce affected lung volume, without effect on SatO2/FiO2 indicator or mechanical ventilation requirement. PLEX therapy provided significant benefits of pro-inflammatory clearance and reduction of 60-days mortality in selected patients with COVID-19, without significant adverse events.

Outcomes and Complications of Tocilizumab and Baricitinib use in Transplant Patients with COVID-19

Background. Immunomodulators have been shown to improve the outcomes of patients with severe COVID-19. However, it is not known if tocilizumab or baricitinib use would be beneficial in transplant patients who are already receiving immunomodulating agents. Moreover, augmented immunomodulation may increase risk of opportunistic infection. There are few studies analyzing the outcomes and complications of these medications in this population. Methods. This is a detailed review of the medical records of all transplant patients who received tocilizumab or baricitinib for COVID-19 indication at our multistate transplant center from April 2020 to March 2022. Results. A total of 57 transplant patients received tocilizumab (n=48) or baricitinib (n=9) for management of COVID-19. Baseline characteristics are in Table 1. 60% had received at least one dose of COVID-19 vaccine. At diagnosis, all patients were lymphopenic (median 0.4 x109 cells/L) with high CRP (median 76.8mg/L) and elevated IL-6 levels (median 145.5pg/ml.). The majority had reduction in transplant immunosuppression (75%) and received remdesivir (86%) and dexamethasone (90%). Majority were admitted to the ICU (68%), including 40% who required invasive mechanical ventilation (Table 2). Almost a third developed bacterial or fungal superinfection. Bacterial infections include respiratory cultures with Klebsiella spp, MRSA, P. aeruginosa, Enterobacter spp and Stenotrophomonas. Blood cultures were positive for Klebsiella spp, MDR P. aeruginosa, E faecalis. Fungal infections include three patients with Aspergillus spp infections who received antifungals. No statistical difference was seen in mortality between patients with infections and not infections group. No statistical difference was seen between type of transplants for infection or mortality. Mortality at 90 days was 46%. Conclusion. Transplant patients who received tocilizumab or baricitinib for severe or critical COVID-19 have poor outcome. This case series found high rates of mortality and opportunistic superinfections after tocilizumab and baricitinib use compared to the current literature. Future directions include a matched case-control study to compare the outcomes in this population.

THE IMPACT OF THE COVID-19 PANDEMIC ON DEMENTIA CARE: A MULTISTAKEHOLDER PERSPECTIVE

Persons living with dementia (PLWD) and family caregivers are particularly vulnerable to the effects of the COVID-19 pandemic. A multi-methods study was conducted to describe the impact of the pandemic on dementia care from the perspectives of stakeholders, including PLWD, family caregivers, and health and social care professionals (HCPs).The study was conducted using a community engaged approach. Cross-sectional surveys were conducted with PLWD (n=27), family caregivers (n=161), and HCPs (n=77), followed by focus groups and interviews with a sub-sample of survey participants (n=55). Participants reported declines in health and quality of life for PLWD and family caregivers. Participants experienced delayed or cancelled dementia care attributed to the pandemic. Most reported telehealth and tele-support were effective alternative models to care. The pandemic impacted the quality and accessibility of dementia care. Results highlight opportunities to improve quality of care through addressing inequities and identifying approaches to address isolation and virtual care.

Upper respiratory tract viral load quantification in COV ID-19 patients at hospital admission and its association with disease severity

Introduction: There are aspects of COVID-19 pathogenesis that are still unknown. Objective: To determine the relationship between severity, mortality and viral replication in patients with COVID-19. Methods: Clinical characteristics, severity and mortality of 203 patients hospitalized for COVID-19 were analyzed and correlated with viral load (VL) and threshold cycle (TC) at admission;nasopharyngeal swab was obtained. Results: Mean VLs in surviving patients with mild to moderate, moderate to severe and severe disease were the following: 6.8 x 10(6), 7.6 x 10(7) and 1.0 x 10(9), respectively;and in patients with critical disease who died, VL was 1.70 x 10(9). TCs were 26.06, 24.07, 22.66 and 21.78 for the same groups. In those who died, a higher mean VL was observed at admission in comparison with those who survived (1.7 x 10(9) vs 9.84 x 10(6);p < 0.001). A significant correlation was observed between VL, severity and death (r = 0.254, p < 0.045 and r = 0.21, p < 0.015). High VL was associated with increased in-hospital mortality in comparison with low VL (OR = 2.926, p < 0.017). Conclusion: SARS-CoV-2 VL determined at hospital admission might classify risk simultaneously with other factors described in COVID-19.

Association between study year and depressive and anxious symptoms during the first months of confinement due to COVID-19 pandemic in a sample of medical students from a private university in Lima, Peru

Objective: To determine the relationship between year levels of medical studies and depressive and anxious symptoms during the first months of the COVID-19 pandemic in a sample of medical students in Lima, controlling specifically the variables sex and presence of underlying medical conditions. Material(s) and Method(s): An online survey collected information from 250 medical students, covering general data, previous medical history and symptoms of depression (PHQ-9) and anxiety (GAD-7). Data were managed using multivariate analysis of covariance. Result(s): Differences were found between years of study and the combined values of PHQ-9 and GAD-7 (Wilks' LAMBDA = 0.86;p = 1.68 x 10-4;eta2p = 0.08). Underlying medical conditions also showed significant differences for the combined values of PHQ-9 and GAD-7 (Wilks' LAMBDA = 0.94, p = 4.43 x 10-4, eta2p = 0.06). The univariate test for year of study showed differences for PHQ-9 (F6.241 = 4.12, p = 0.001, eta2p = 0.09) and GAD-7 (F6.241 = 2.81, p = 0.01, eta2p = 0.07). The post hoc analysis showed statistically significant differences in the first years of study. Conclusion(s): These results suggest that medical students of the first years show higher levels of depression and anxiety symptoms than participants from more advanced years of the medical career. Likewise, the occurrence of previous medical conditions also explained high levels of depression and anxiety. Copyright 2022 With Intelligence Ltd.

Bovine reproductive and productive parameters in milk production systems during times of COVID 19

In order to analyze changes in bovine reproductive and productive parameters in dairy herds because of the COVID -19 pandemic, an investigation was carried out in the Province of Santo Domingo de los Tsachilas, Costa Region, Ecuador. To collect the information, research techniques (surveys, structured interviews and group sessions) were used from 86 producers belonging to the Producers Province Association. Where the variables were studied: age at first service (EFS), age at first calving (EFC), types of service (TS), age at weaning (EW) and milk production (ML) before and during COVID-19. The data collected were compared using Chi square tests and the likelihood ratio. The PL was compared with the Student's t-test for paired samples. The EPS, EPP and ED were not significant;but, an increase in the proportion of natural mounts (P<0.01) of 36 % was observed, to the detriment of artificial insemination. There was a decrease in ML (P<0,01) from 8.3 to 8.0 litres.cow(-1). In conclusion, the pandemic caused by COVID-19 has negative consequences on milk production systems.

Parainfluenza Type 3 Infection in Solid Organ Transplant Recipients

Purpose: Respiratory viral infection, including COVID-19, causes significant morbidity and mortality in solid organ transplant recipients (SOTR), however, the data of parainfluenza virus (PIV) type 3 infection in this population is still limited. The aim of this study was to reveal the clinical picture of PIV type 3 infection in SOTR. Method(s): This was a retrospective cohort study, conducted between 01/01/2017 and 08/31/2021. We included adult SOTR with an active graft whose respiratory specimen, either nasopharyngeal swab or bronchoalveolar lavage, was positive for PIV type 3 via Filmarray 2.0 and Torch, BioMerieux. Lower respiratory tract infection was defined as any chest radiological abnormality. Result(s): We identified 25 patients including 14 kidney, 4 lung, 3 heart, 1 liver, and 3 combined transplant recipients (Table 1). Hospital and intensive care unit admission rate was 88% (22/25) and 16% (4/25), respectively. Lower respiratory tract infection was seen in 44% (11/25). No specific treatments for PIV type 3 were given to this cohort. Co-, secondary infection was observed in 4 (16%) SOTR with 2 Enterovirus/ Rhinovirus, 1 Fusobacterium bacteremia, and 1 Pseudomonas aeruginosa pneumonia. Only 2 (8%) died within three months after diagnosis. Conclusion(s): PIV type 3 in SOTR showed favorable outcome and no episodes of rejection occurring during follow up. Further studies should be needed to identify the risk factors for mortality.

Analysis of Emergency Medical Technicians' diet and adherence to the Mediterranean diet, and their evolution during the COVID-19 pandemic in relation to sociodemographic and health factors

Introduction: Emergency Medical Technicians show a high prevalence of overweight and obesity, which have been related to a low adherence to the Mediterranean diet and several health problems. Objetives: Describe the diet and the adherence to the Mediterranean diet in a sample of Emergency Medical Technicians in Spain and their evolution during the COVID-19 pandemic considering the sociodemographic and health fac-tors related to them. Material and Methods: The participants completed an online survey which collected: sociodemographic variables, food consumption, food choice, self-efficacy consumption of fruits and vegetables, changes in diet during the pandemic, sleep quality and stress symptoms. Adherence to the Mediterranean diet and the relationship between these variables were calculated. Results: 340 professionals participated. Less than 25% met the recommended intake of vegetables, fruits and cereals, and less than 35%, the intake of confectionery, red meat and nuts. Technicians with a low adherence to the Mediterranean diet chose less healthy dishes (p<0.001) and had lower self-efficacy (p<0.001). Besides, technicians whose diet quality got worse during the pandemic pre-sented poorer sleep quality (p=0.025) and more stress symptoms (p<0.001). Discussion: Emergency Medical Technicians show a low adherence to the Mediterranean diet, which was associated with a low self-efficacy and poor food choices. Conclusions: Interventions to improve Emergency Medical Technicians' diet quality should focus on improving their self-efficacy, food choice, sleep quality and stress levels.

Responsible ownership of companion animals under the ..One Health.. approach. Compilation study

Pet ownership (PO) exerts beneficial effects on the physical and psycho-emotional health of the people with whom they live, even in pandemic contexts. Animals benefit from receiving attention and care and avoiding health risks, based on the ..One Health.. approach. Considering the contributions and importance of the subject, a compilation study of works carried out by the authors was carried out to determine the perception of the benefits of PO in different population sectors. These were exploratory and descriptive studies, cross-sectional and quantitative conducted at the National Institute of Endocrinology and the main Veterinary Clinic of Havana, in which people responsible for companion animals (PO). These people had chronic diseases (cardiovascular and endocrine-metabolic), sexual and reproductive health conditions (infertility) and sexual identity (homoerotic and transsexual sexual orientation), in different stages of life (middle and elderly), from 2013 to 2020 (during the context of the COVID-19 pandemic). Selfadministered questionnaires prepared by the research team were used. The results were processed using descriptive statistics and ethical aspects were considered. Most of the participants expressed satisfaction with PO, perceived its benefits on their physical and emotional health, motivated them to take better care of themselves and engage in physical activities, and during the COVID- 19 pandemic. Besides, PO decreased the negative effects of social distancing. Dogs and cats were the preferred animals for emotional reasons.

Outcomes of COVID-19 in Recent Kidney Transplants Recipients at a Large Transplant Center in Miami

Background. Outcomes of COVID-19 have been reported in deceased donor kidney transplant (DDKT) recipients. However, data is limited in patients that underwent recent DDKT. Methods. This single-center retrospective study evaluated the differences in demographics and post-transplant outcomes between those who tested positive and negative for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, after undergoing recent DDKT. The treatments and outcomes for the SARS-CoV-2-positive patients were assessed. Patients who underwent DDKT from 3/2020 to 8/2020 were included and followed until 9/2020. Results. 201 DDKT recipients were analyzed [14(7%) SARS-CoV-2-positive and 187(93%) negative]. There was no difference in delayed graft function and biopsy-proven rejection between both groups. The patient survival at the end of the study follow-up was lower among SARS-CoV-2-positive patients (Table 1). The median time from DDKT to COVID-19 diagnosis was 45 (range: 8-90) days;5(36%) patients required intensive care unit and 4(29%) required mechanical ventilation;steroids were used in all the patients, therapeutic plasma exchange (TPE) and convalescent plasma (CP) in 7(50%) patients each, remdesivir in 6(43%) and tocilizumab in 1(7%);9(64%) patients recovered, 3(21%) died and two were still requiring mechanical ventilation at the end of the follow-up. Conclusion. Our cohort demonstrated a lower survival rate among SARSCoV-2-positive patients, which highlights the vulnerability of the transplant population. Transplant patients must comply with the CDC recommendations to prevent COVID-19.

Comparison between SARS-Cov-2, non-SARS-Cov-2 Coronavirus, Influenza and RSV Infections among Solid Organ Transplant Recipients

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019 and has shown worse outcomes in solid organ transplant recipients (SOTR). The clinical differences as well as outcomes between these respiratory viruses have not been well defined in SOTR. Methods. This is a retrospective cohort study of adult SOTR with nasopharyngeal swab or bronchoalveolar lavage PCR positive for either SARS-CoV-2, non-SARSCoV-2 coronavirus, influenza, or respiratory syncytial virus (RSV) from January 2017 to October 2020;both inpatient and outpatient. The follow up period was up to three months. Clinical characteristics and outcomes were evaluated. Development of lower respiratory tract infection (LRTI) was defined as new pulmonary infiltrates with or without symptoms. For statistical analysis, Fischer's exact test and log rank test were performed. Results. During study period, 157 SARS-CoV-2, 72 non-SARS-CoV-2 coronavirus, 100 influenza, 50 RSV infections were identified. Patient characteristics and outcomes are shown in tables 1 and 2, respectively. Secondary infections were not statistically significantly different between SARS-CoV-2 vs. non-SARS-CoV-2 coronavirus and influenza (p=0.25, 0.56) respectively, while it was statistically significant between SARS-CoV-2 and RSV (p=0.0009). Development of LRTI was higher in SARS-CoV-2 when compared to non-SARS-CoV-2 coronavirus (p=0.03), influenza (p=0.0001) and RSV (p=0.003). Admission to ICU was higher with SARS-CoV-2 compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.0001) and RSV (p=0.007). SARS-CoV-2 also had higher rates of mechanical ventilation when compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.01) and RSV (p=0.03). With time to event analysis, higher mortality with SARS-CoV-2 as compared to non-SARSCoV-2 coronavirus, influenza, and RSV (p=0.01) was shown (Figure 1). Conclusion. We found higher incidence of ICU admission, mechanical ventilation, and mortality among SARS-CoV-2 SOTR vs other respiratory viruses. To validate these results, multicenter study is warranted.